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Of novartis product, the reported AEs mainly affected the digestive system with mild to moderate abdominal distension, diarrhea, flatulence, and abnormal GI sounds. Moderate AEs, such as rumbling or abdominal pain, were novartis product more frequently after intake of the 30 g liquid lactulose. Overall, none of the AEs were serious, and no AE led to study discontinuation or modification of the study product dosage.

Overall, novartis product study products were well tolerated. The present study tested the hypothesis that single oral doses of 20 g and 30 g of crystal and liquid lactulose have no clinically relevant impact on blood glucose levels in mildly constipated, non-insulin-dependent subjects with T2DM.

The study was designed as novartis product prospective, double-blind, randomized trial with a four-period crossover and incomplete block design. Another study objective was to compare the two lactulose formulations in terms of blood glucose concentration-time responses.

According to the prescribing information, the recommended novartis product dosage range of lactulose in adults with chronic constipation is 10-20 g per day, both for crystal and liquid formulations. The higher dose of 30 g per day can be indicated as a starter dose, to achieve an novartis product laxative effect. Merely after the intake of 30 g liquid lactulose, a small significant increase in calculated blood glucose parameters Cmax and maximum increase compared to water (negative control) was observed.

However, in the interpretation of this result, it should novartis product taken into account that maximum increase is a secondary novartis product in our study and is solely based on a single sampling point and calculation. Furthermore, individual glucose profiles showed a rather heterogenic pattern with novartis product values occurring at different times ranging between baseline and 180 min (as a second peak) after administration.

Thus, this observation presumably appeared due to random novartis product and is unlikely to be induced by 30 g liquid lactulose.

The observed result is clinically not relevant, since the upper limit of the Novartis product is clearly below the 2. It is notable that the carbohydrate impurity amount and pattern in lactulose products vary depending on the manufacturing process conditions. A different brand may, therefore, have a higher content of impurities, which may have novartis product the reason for the increase in blood glucose levels described in this case report.

The intake of novartis product the 20 g and novartis product g lactulose doses, regardless of the formulation, resulted in a slight net novartis product in blood glucose concentrations of approx. This decrease, however, was within the normal physiological range novartis product fasting blood glucose and comparable to what was observed after intake of water.

Lactulose-induced impairment of intestinal carbohydrate uptake and carbohydrate metabolism was not observed novartis product fasting conditions. The blood glucose concentrations remained largely stable despite a continuous fasting period for 3 h after oral novartis product of lactulose.

Therefore, there novartis product no risk for hypoglycemia after oral lactulose intake in individuals with T2DM. With regard to safety and tolerability, the GI symptoms experienced by the participating subjects after single oral lactulose intake are well known. The reported Novartis product included diarrhea, flatulence, and abdominal discomfort novartis product, as expected, were reported more frequently after intake of the higher lactulose dose.

Usually, GI symptoms disappear after some days of novartis product treatment. Most treatment-emergent AEs were mild to novartis product in severity, considered to be related to the study treatment, and resolved by the end of the 24 h posttreatment observation period.

Overall, lactulose was well tolerated, and no unexpected safety issues were identified. In contrast to other laxatives, lactulose is metabolized by gut bacteria, thereby contributing to the maintenance or novartis product of a healthy colonic microbiota. Other types of laxatives (e. Specifically, bulk-forming laxatives may interfere with the absorption of medications commonly prescribed for use by older subjects (e.

These individuals may particularly benefit from the prebiotic effect of this laxative without experiencing an impact on blood glucose levels and glycemic management. The present study has several strengths and limitations. First, an obvious strength is that the study novartis product conducted in a relatively short time period, with high reliability and power.

Second, the intention-to-treat population was identical to novartis product per-protocol population in this study. One limitation of the current study is that subjects may have distinguished between water and the other study products due to the slightly sweet taste of lactulose and glucose. Although subjects were blinded to both the dose and formulation of lactulose, as well as both control products, it was not feasible to ensure an identical taste of all study products.

Therefore, a potential impact of this confounding factor on the blood glucose response is not expected. Adherence of subjects to the pre-visit restrictions was verified using diaries novartis product questionnaires that novartis product checked by the investigator at the start of each study visit. In case of noncompliance, the study visit was to novartis product postponed. Thus, the potential bias is considered negligible.

All lactulose doses and formulations were novartis product tested in a single oral dose. During the study, 16 participants received novartis product different lactulose doses, while 8 participants received two different lactulose doses.

We assume that repeated daily doses will unlikely impact blood novartis product levels if single novartis product do not increase blood glucose levels. Eventually, applying the listed inclusion and exclusion novartis product, the study population consisted exclusively of outpatients with T2DM and mild constipation without any endocrine or Novartis product comorbidities.

Since our aim was to specifically investigate the effect of lactulose on blood sugar response, we defined these meditations to ensure that any confounders masking the potential effects of lactulose, such novartis product medications or comorbidities, novartis product be ruled out.

We consider the study population to be representative for the patient group who may benefit from lactulose novartis product. Lactulose increased the number of bowel movements with only mild to moderate known GI side effects. Lactulose products contain carbohydrate impurities that occur during the lactulose novartis product process.

Currently, there is no information on whether lactulose in marketed formulations (crystals and liquid) has an impact on the blood glucose profile in mildly constipated, non-insulin-dependent subjects with T2DM. The main objective was to assess possible changes in novartis product glucose levels after oral intake of lactulose novalgin sanofi mildly constipated, non-insulin-dependent subjects with T2DM in an outpatient setting.

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